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Multicenter Development of a Clinical-Molecular Nomogram for Predicting Survival in Lung Cancer Brain Metastasis
Xiansheng Qiu1,2, Zhenwei Lu1,2, Chongfei Li1,2
1The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
Background:
Lung cancer brain metastasis (LCBM) accounts for 40-50% of intracranial malignancies, with emerging evidence of alternative metastatic pathways circumventing the blood-brain barrier. Existing prognostic models lack validation in Asian populations and molecular stratification. This multicenter study aimed to develop a clinical nomogram integrating clinicopathological and molecular determinants for personalized LCBM management.
Methods:
Retrospective analysis of 522 surgically treated LCBM patients (2015-2021) from four Chinese institutions was conducted. Patients were randomized 7:3 into training (n=365) and validation (n=157) cohorts. Multivariate Cox regression identified independent prognostic factors, which were incorporated into a nomogram predicting 6-/12-/18-month overall survival (OS). Model performance was assessed via time-dependent ROC curves (AUC), calibration plots, and decision curve analysis (DCA).
Results:
The median OS after neurosurgery was 9 months (range: 4-18 months), with 6-, 12-, and 18-month survival rates of 86.2%, 46.7%, and 17.2%, respectively. Independent predictive factors included brain metastasis size ≥5 cm, Leptomeningeal metastasis(LM), EGFR mutation with TKI treatment, and extracranial metastases. The nomogram demonstrated robust discriminative ability and calibration. EGFR-mutant patients receiving postoperative TKIs showed significantly prolonged survival attributable to enhanced blood-brain barrier permeability. Finally, the authors developed a web-based dynamic nomogram for LCBM patients to facilitate clinical implementation.
Conclusion:
This study establishes a validated prognostic model integrating tumor burden, EGFR mutation status, and metastatic patterns. It demonstrates that EGFR-guided TKI therapy and bone metastasis surveillance critically influence LCBM outcomes. The nomogram provides a quantifiable framework for risk-adapted therapeutic decisions, advancing precision oncology in neuro-oncology practice.
